‘If you can find the money to kill people, you can find the money to help people.”

You don't have to be a blind conservative not to see it, just an ignorant one to deny it.

Having seen the movie last Friday night, I can attest: it's brilliant, and it's a must-see. Certainly for everyone who reads TPMCafe, but the whole damn country should see this movie.

Moore's brilliance is in the simplicity of it all. He goes to other countries, and they laugh at our system. It's shameful. We love to talk platitudes about America and our "Values," but when it comes down to taking care of each other, well, we don't.

The simplicity of Moore's message is summed up in his trip to Cuba -- outside of Gitmo, he picks up a mic, and pleads: "We just want the same medical care as the evildoers."

When the soldiers at Gitmo know the prisoners get much better health care than they do, and their families do, it's a real problem.

This is a problem that capitalism and "free markets" cannot solve. Making money and providing healthcare are at odds. Moore makes this clear in the movie. We already have government-run organizations, whenever it comes to safety and matters of life and death: police, EMT, fire, etc. 

Well, this too, is a matter of life and death. 

Give us some socialized medicine, damnit.

"Thank God George Bush is our president." -Rudy Giuliani

Nice post.

I would just observe that when I have read the comments on reforming heealthcare on quite liberal blogs, there seems to be a preponderance who consider that there is little to learn from foreigners. It is remarkable how deep that "best health care in the world" is ingrained.

Sort of the same thing "best" (or "greatest", choose your own adjective) "country in the world". Just lately Blair, for one, thought differently on announcing his retirement as PM. It's so presumptive.

There are lots of reasons why health care is not your normal market but it is surely undeniable under any cold, clear eye that our system fails and continues to fail in comparison to every other advanced nation's system when measured against cost, accessibility and outcome.

There is surely something out there we need to learn.

This is a great comment; it made me challenge my own presumptions about what kind of propaganda (and I do think that Michael Moore is a propagandist-a skillful one) would work best in affecting our health care system to change.

The problem for me was that Cuba, especially since the loss of Soviet monetary support, no longer can afford any of the medical technological bells and whistles of many Western nations and is even low on basics at times. And I read that the Americans that Moore took there for treatment got A1 level treatment that most citizens there don't (for propaganda purposes, of course.)

Now when people find out that fact in post "Sicko" arguments, it doesn't hurt Cuba's reputation for having excellent caring general care doctors and universal coverage, but it may not convince those who have always argued that we have all the bells and whistles now for those with excellent coverage and we don't want to get rid of those....it's the old arguments against "socialized medicine." Those are the "Harry & Louise" affectable people that need convincing; there's no good in preaching to the choir.

But your bringing up the "shame" theme, now that might work.

On the longevity and population health issue, if one is to be honest, the factors are too complicated to give the gold star to Cuba as best in the world. Granted, what they've managed to do is still a miracle, take a third world environment and raise the life expectancy to the same level as the U.S. What it is to me is a testament that good primary physician preventative care for all can work miracles. See Michael Moore's Math: ‘Sicko,’ Castro and the ‘120 Years Club’ by Anthony DePalma for more on some of the problems of comparing apples and oranges as far as life expectancy is concerned (not to mention that, no Michael, they do not live longer than us on average, that life expectancy is the same, and that the very slightly lower infant mortality could be just as much due to the higher abortion rate as many other factors.)

The "shame" thing is the way to go--if Cuba can do this with what it has, the U.S. should be able to do MUCH better.

Tanner is incorrect. The recent study published in JAMA comparing 55 to 64 year old non-Hispanic whites in the U.S. and the U.K. does compare
"disease by disease" comparing diseases and
disease markers.

Other studies published in our medical literature show other countries are better at
treating specific disease than we are.

When compared to the U.K. Australia,New Zealand
and Canada we are worst when it comes to kidney
transplant survival. When it comes to colon cancer survival we are second worst in the world.

When it comes to treating cystic fibrosis, we
are #2 in the world-- Denmark is #1.

Many countries have better(and more) palliative care, better mental health care, better asthma control, better preventive care. . .
All of numbers above are from the highly regarded Institute for Health Care Improvmet here in the United States.

We spend a fortune on care for heart patients, but Canadians suffering from heart diseasefare better than very similar Americans. (As has been recently report in the NYT and medical journals, We do waytoo many bypasses and angioplasties--both because these are very lucrative procedures and because we tend to be in a hurry to "do something" rather than treating with drugs and
exercise. Unfortunately, these aggressive procedures carry risks, and so overtreatment can be deadly.

Just a couple of days ago my local newspaper carried a letter to the editor that raised the "that's socialism" boogieman very stridently. The gist of the letter is, so what if universal, single payer health care is the best care in the world, it is the foot in the door to socialism, and we have to fight that to the bitter end. I can't find any effective words to counter that mindless idea. But, it seems to me that an awful lot of Americans believe fervently that any move towards socialism is the full equivalent of damnation to an eternity in Hell.

Hoppy in Sacramento

jhaber, there are plenty of stories out there and I have no direct experience of foreign care beyond living in the UK for a while when it was always excellent. I was a sportsman and, beyond the usual kid's stuff, tended to visit the emergency room of various hospitals. With soft-tissue injury, on three separate occasions, I was referred to one of the London teaching hospital's sports injury clinics. Excellent initial treatment and highly effective out-patient rehab. None of those injuries recurred.

French doctors still make house calls. I don't know if the Brits do, except for serious home care. My mother certainly did as she was dieing from a returned cancer, also with excellent home hospice support. They were wonderful.

And I know 4 travelling US friends, so second hand information, with experience. One couple got food poisoning travelling from Eire to France; got great treatment for like $50. One had a minor injury treated for zilch in the UK. The last got free treatment in the Netherlands for minor stuff.

All were relatively trouble free and pleasant experiences, not to say some sense of relief over the bill. Imagine if it was some French or Dutch person walking into a US emergency care for stitches?

Frankly, I can't!

repeats above

Believe it or not, if an American goes to the
UK, he/she is eligible for free health care.

I can testify to this from two cases in my own experience.  The most recent was in 1997, so I don't know what may have changed.  But that year I managed to pass a bladder stone (no gory details) and was treated as an outpatient for free.  Ten years or so before that, a student in an study group I was conducting had a foot run over by a gasoline lorry which turned the corner from Gloucester into Cromwell roads too sharply, the rear wheel running over her foot.

The St. John's Ambulance took her to the nearest Hospital.  I rode along, she went into the emergency room:  I went into the waiting area where one of the Sisters (Nurses, to us) brought me a cup of tea.  She received stellar care, and a follow-up visit and the use of a cane (nothing broken, just stretched ligaments, thank goodness).  All of this with no charge.  At this point I began to laud the praises of the English system, and I'm still lauding them.

Thanks for the brilliant post (I figured I'd use a common British adjective) Maggie.  It brought back some fond memories of compassionate strangers.

aMike

Well, nobody has mentioned it so I will. When comparing health care costs and mortality of Americans to people in other countries you must factor in the poorer physical condition of Americans (their fatness has been mentioned). Foreigners tend to walk a lot, and walking is basic to good health.

We have socialized police and fire protection, socialized road and highway planning, construction and maintenance, socialized public education and higher education and in many places, socialized water and power utilities. And guess what, we haven't been naming our children Leonid or building statues to Marx in the neighborhood parks.

The industries we socialize are for the common good - something all need such as police,fire,education, roads, etc. The question is why we don't think health care fits into that set of public goods that are needed by all people instead of looking at it as a commodity -- even a luxury.

Very nice post, Maggie.

I am very interested in the JAMA study you cite.
I tried to Google it but couldn't find it. Any chance you have a link handy (assuming it's on the web)? Thanks.

Re: The JAMA study comparing non-Hispanic whites 55-64 year olds in the U.S. to those in the U.K> controlled for lifestyle factors
including exercise and obesity-- and still, the Americans were much less healthy.

I wish someone could explain how this study rated health, because it seems right out the gate our healthcare system (and several other factors of our lives) will make us look less healthy in comparisons even if we aren't.
For people with insurance (the majority of us) our healthcare system is biased toward over-diagnosing and over-treatment. And we certainly spend more money on it! Moroever the paucity of vacation time means that many (most?) people call in sick when they aren't but need a day off. And at the end of life we have a tendency to delay the inevitable longer than most countries do, so we have more seriously ill people among us. Finally too, our large population of poor people many living in Third World conditions probably also skews our stats downward.

My experience with foreign health care was in Mexico in about 1994. I was diving for a few weeks in Cozumel and I got a very bad sore throat and fever, I went to the "social security" hospital, they were very kind and took me to the front of the line and right in to see a doctor, he was young and spoke excellent english (my spanish is not so good), the facility was not so fancy as the places at home (California) but he examined me, chatted amiably, wrote me a perscription, granted I had to hold a flashlight a couple of times when the lights went out, but they were very gracious, I asked about payment and was told I could make a donation at the front desk if I wanted to. The perscription was $100 at a pharmacy in town but it worked quickly.
Nowdays I go to Mexico for dental work and just had 3 fillings, 11 crowns and an implant done for under $5000. It is different there, but not that different, I've interviewed 7 or 8 dentists there in the last 3 years and had 4 do work for me. There is all levels and qualities of service available there, pick your dentist with care, ask friends or locals for references. I vote for some type of socialized medicine, how about the best of Canadian, and European plans? But it has to cover everyone. I will go to Mexico for specific types of care if I need it. My local (US) doctor or dentist will advise me.

Thanks, Nobelesseoblige.

Here's a link to the JAMA article: http://jama.ama-assn.org/cgi/reprint/295/17/2037

(If for some reason it doesn't work, e-mail me
at maggiemahar@yahoo.com and I'll send it to you
as an attachment.)

Thank you for the information. Tanner arguews for exoguous info and I presumed he was inaccurate but did not know the information.

Daniel A. Greenbaum

I thought Malcolm Gladwell debunked the "moral hazard" myth of too much care. Worth tracking down in the New Yorker. Sorry to say I've forgotten the title.

The main question is: should individual health be a public-health issue? If yes, universal care is called for. That is, if we feel that a public effort at achieving some kind of reasonable health goal for all would benefit all, we make it universal and free of charge.

The question of what should be expected in longevity, and in the way of extraordinary efforts, is then debatable by all, for a consensus. Wealth will always buy more health, here, but we can set a floor.

Actually, Malcolm did't debunk the the "moral hazard" myth.

In fact he himself changed his mind in 2006
about what he had written in The New Yorker
six years earlier. (See http://www.washingtonmonthly.com/archives/individual/2006_02/008302.php.)

JPF311 -- I am rather skeptical that we Americans (other than our poor) are in all that bad of shape relative to foreigners.

Of course the simple point is that the universal health care countries DON"T leave out the the poor. And that answers your second post, too.

The truth in the US is that many people do not seek or get the medical help they need. There are many frictions: taking time from work is a no-no; co-pays can be inhibitive and are becoming more so; people don't shell out for the prescriptions, or not fully; etc., etc.

Frankly, I think you are not connected to the average life in the US re medical care. The facts that you seem to doubt speak for themselves.

So why can't this guy get some more traction?

Tell your U.S. House Representative to support H.R. 676.

Note the list of 71 co-sponsors. Not a single Republican.

When you travel to Europe (Italy, France, Netherlands, etc.), you don't see a lot of fat people. Not like you see here. Anecdotal, of course. 

Diet is very different. We eat a lot of shit.

A very interesting story-- thank you.

I do not disagree with you one iota about universal care. I am simply expressing due and proper scientific skepticism about a study which (as far as I know) has not been replicated by anyone else and whose results are easily explicable as data artifacts.

I recently saw an article that "eating ground, cooked meats requires fewer calories to digest your food." (source)

as more and more processed foods enter "third world countries," they'll get fatter as they use less energy to break down their foods.

To boldly go...

Anecdotal of course, but I would agree there seem to be far fewer morbidly obese people (at least in places where tourists are likely to stray) but no shortage of overweight people in Europe.

I'm sorry-- I confused two different Gladwell pieces on healthcare. In the New Yorker,he
wrote about moral hazard.

Some years earlier he had debated Adam Gopnik
on healthcare in Washington Monthly--that was the piece I was thinking about. (In that
debate Gopnik defended Canadian healthcare and
Gladwell defended the U.S. system. Six years
later Gladwell said that he had been wrong
and Gopnik was right-- the Canadian system made
more sense.)

Anyway, what threw me off initially was Tom's
suggestion that by "debunking moral hazard"
Gladwell was "debunking overtreatment."

These are two different cocepts. Moral hazard
refers to the danger that someone who has
good insurance will over-use the health care
system, going to the doctor more often than they
need to etc. Therefore,some people say that we need higher co-pays and deductibles so that people wiil think twice about using healthcare.

In the New Yorker article, Gladwell disagrees. He argues that the problem
with our health care system is not that people
have too much health insurance but that too many people have too little (or none). (See http://www.gladwell.com/2005/2005_08_29_a_hazard.html.

But none of this has to do with "overtreatment"--
which refers,not to patients seeking out more
care than they need, but to doctors and hospitals PROVIDING more care than patients need in the form of unnecessary surgeries, ineffective, sometimes unproven procedures, unwanted end-of-life treatments, and over-priced,sometimes not fully tested "bleeding-edge" drugs and devices.

MOre than two decades of research done by physicians at Dartmouth reveals that much of this over-treatment is driven by supply: In towns where there are more specialists and more hospital beds, patients receive much more intensive, expensive and agressive treatment-yet when you look at outcomes they fare no better--often they do worse. I've written about this for Dartmouth Medicine's Spring 2007 issue. http://dartmed.dartmouth.edu/spring07/html/atlas.php.

Sorry again for the confusion.

Thanks for clarifying.

I suppose we have to disentangle provider charges vs. patient cost. Overtreatment seems a minor worry in the whole debate, which is mostly about intitial treatments, and continuing care for chronic or permanent conditions (the kind that bankrupt families).

At this point health care researchers are saying
that overtreatment is a huge problem--that $1 out of $3 healthcare dollars is wasted on unncessary procedures, tests etc.

You're right-- chronic diseases account for a huge share of our health care spending--and that is where much of the overtreatment can be found.
What many chronically ill patients (suffering fromdiabetes and heart disease,for example,) need is preventive care-- not 11th hour-aggressive care.(amputations and bypass surgery)

What many cancer patients need is palliative care--not a third round of ineffective chemo . . .

If I had to sum up what is wrong with our
healthcare system in two sentences I would say
that while many Americans (the uninsured, the underinsured and people on Medicaid) receive too little care, others (the well-insured and many on Medicare) often receive too much care. And this is not just a waste of money--overtreament can be hazardous to your health

Re: Of course the simple point is that the universal health care countries DON"T leave out the the poor. And that answers your second post, too.

The original claim made by the study mentioned somewhere above is not that our poor are unhealthier than the poor of other First World naions (that I think is easily understandable) but rather that America's rich are unhealthier than people on other nations. That's a bit harder to swallow.

As for being "in shape" I am rather skeptical about that claim (that America is uniquely out of shape) since it far transcends our healthcare system. Indeed, most people who are "in shape" do not get that way by going to doctors; they may in fact have very little to do with doctors. Being out of shape (eating too much of the wrong foods and getting too little exercize) is a problem for the world in general, everywhere that food, especially starches and sugars and fats, is cheap and everywhere that work no longer means physical toil but involves sitting at a desk 8 hours or more per day. That's pretty much all of Europe, plus Canada, Australia, and much of the Pacific rim of Asia. We could institute single payor tomorrow and it would not do one iota to solve that problem. I don't think anything will until we can figure out a way to set our metabolic rates on high even if we are on our butts most of the time.

Re: Frankly, I think you are not connected to the average life in the US re medical care.

You suppose quite wrong. I used to work in health insurance IT and like everyone else I have occasion to go to the doctor now and then. I have mild asthma, and a few years ago I survived a rare and potentially fatal illness. I also cared for my father while in college during his long decline due to emphysema. I think I've put in my time with the American healthcare system. Isolated I most certainly am not.
I think you are reading way more into my words than is there. Check out anything I have ever written on TPM on this topic. I am skeptical for political reasons that we could institute single payor, but you will never find me arguing anywhere that it is not imperative that we create some kind of universal coverage system.